对社区内糖尿病患者进行社区-医院一体化管理的效果分析

摘要

Objective:To explore the value of community-hospital integration management to the patients with diabetes mellitus in the community. Methods:All 12 communities were chosen under two community health stations' jurisdiction (WangXianPo community health station and ChaoYang community health station), and 1 535 patients with diabetes mellitus were discovered in the first visit, 350 patients were randomly chosed into the group and ac-cepted community-hospital integration management, relevant scores of self-management and the conditions of con-trolling glucose were compared before and after intervention. Results:Postprandial blood glucose and fasting blood glucose of the patients after intervention were significantly lower than these before intervention (P<0.05), the scores of diet, exercise, medication and blood glucose monitoring management of the patients after intervention were no-tably higher than these before intervention (P<0.05). Conclusion:The patients with diabetes mellitus under commu-nity-hospital integration management could enhance therapeutic compliance of the patients.%目的：探讨对社区糖尿病患者进行社区-医院一体化管理的应用价值。方法：选择2个社区卫生服务站（望仙坡社区卫生服务站和朝阳社区卫生服务站）所辖12个社区初诊发现的糖尿病患者1535例，随机收取350例入组，采用社区-医院一体化管理，并比较干预前后血糖控制情况，以及自我管理相关得分。结果：干预后患者餐后血糖和空腹血糖均显著低于干预前（P＜0.05），患者饮食管理、运动管理、用药管理和血糖监测管理得分均显著高于干预前（P＜0.05）。结论：糖尿病患者社区-医院一体化管理能提高患者治疗依从性。